HPV vaccinations: don’t forget the boys

From January 2017 both boys and girls will be offered free vaccine protection against human papillomavirus (HPV), which causes genital warts, cervical and some other cancers.

October 28, 2016

Nearly a decade after New Zealand began offering the cancer-preventing HPV vaccine to girls for free, we are to follow Australia in offering it free to boys too.

Not only is the vaccine going to be available to both sexes that can be affected by HPV-associated cancers but also the age of eligibility has been extended to 26 and a new vaccine covering more cancer-causing strains is to be used.

The majority of sexually active people will be infected in their lifetime by one of the many types of HPV that affect the genital area and most will clear the virus without any complications. But about 25 per cent of infected people will develop genital warts and some infected people will go on to develop HPV-associated cancer. The most prevalent of these is cervical cancer (which killed 56 New Zealand women in 2012) but HPV can also cause rarer cancers like anal, penile, vulval, vaginal and some forms of throat cancers.

It is the growth in oral and throat cancers – especially in men – that has partly been behind a growing push worldwide for the vaccine to be offered to boys as well as girls.

Also the ‘herd immunity’ effect of protecting people from the sexually transmitted virus and associated cancers would be improved if both sexes, not just females, were vaccinated. This is particularly so in New Zealand as the uptake of the HPV vaccine since its introduction in 2008 has hovered below the national target of 60 per cent of 12-year-old girls being immunised.

The relatively low uptake has not been helped by some active social media campaigns questioning the safety of the vaccine. These campaigns continue despite the Ministry of Health reporting large clinical trials involving 20,000 people from 30 countries – including New Zealand – have shown the vaccine to have a good safety profile; and reactions reported from HPV immunisations being similar to other immunisations with the most common being injection site pain, redness and swelling.

Throat cancer patient Dr Grant Munro, a scientific expert on viruses, spoke to the New Zealand Herald earlier this year about his decision to pay for his teenage son to be vaccinated against the sexually-transmitted HPV virus. The patient-representative of New Zealand’s HPV Project, whose own cancer has been linked to HPV, said he considered the Government’s policy of only making the vaccine free for girls as a form of discrimination against males.

The United Kingdom’s NHS Choices website says major risk factors for oral cancer are alcohol and smoking but 25 per cent of mouth and 35 per cent of throat cancers are HPV-related and it is likely that oral sex is the primary cause of HPV infection in the mouth.

Child and youth health NP Paula Renouf says she wholeheartedly supports HPV vaccination of boys and men and the new vaccine will protect both men and women from almost all the strains of HPV that cause genital cancer as well as oral/throat cancers.

Youth Health NP Rebecca Zonneveld said the Evolve Wellington Youth Service has seen a significant drop in genital lesions caused by HPV infection since the vaccination programme began and anticipates a drop in HPV-associated cancers will follow.

“We have been there when young people who demonstrate a devastating HPV infection realise that it could have been prevented,” says Zonneveld. “Even those who marry having never been with anyone but their new spouse can be infected and face the same consequences. Why allow this to happen when infection is so preventable?”

KEY FACTS for HPV VACCINE CHANGE (from 1 January 2017)

Boys and young men are now also eligible for the free human papillomavirus (HPV) vaccine.

Age eligibility is extended from present under-20 years to all people up to the age of 26 years.

Current HPV Gardasil vaccine (that targets four high-risk HPV serotypes) will be replaced with the Gardasil-9 vaccine that targets nine serotypes.

HPV causes genital warts and can cause a number of cancers with the most prevalent being cervical cancer but also rarer cancers like anal, penile, vulval, vaginal and some forms of throat cancers.

The 2008–2016 vaccine targets two HPV serotypes (16,18) that cause 70 per cent of cervical cancers and other HPV-related cancers plus targeting the two HPV serotypes (6,11) that cause about 90 per cent of genital warts

The 2017 Gardasil-9 vaccine covers five additional serotypes that cause a further 20 per cent of cervical and HPV-related cancers.

A two-dose schedule will be funded for children 14 and under through the schools programme (starting year 8 in 2017 and moving to starting year 7 in 2018).

A three-dose schedule will be funded for people aged 15–26 through primary health providers.